Possibilities for reform

After a long winter for health-care reform following the failure of the Clinton plan in 1994, a number of proposals are suddenly blooming at the state level in Wisconsin and across the nation.

In his budget proposal, Gov. Jim Doyle outlined a major consolidation of public programs into "BadgerCare Plus." The new program would focus on providing coverage to childless adults. Coupled with a higher cigarette tax and a new tax on hospitals (nonprofit hospitals earned a surplus of $1 billion in 2005), Doyle hopes BadgerCare Plus can bring the percentage of Wisconsinites covered by health insurance to about 98%.

Advocates of fundamental health reform are delighted by Doyle's plan, which they think makes their own, more ambitious plans affordable and achievable. In the running are three main plans:

The Wisconsin Health Act: Chiefly authored by former state budget director David Riemer and Lisa Ellinger, this would require all firms to pay into a state fund that would provide health coverage for all citizens. The most market-oriented of the major proposals, it leaves room for multiple insurers and even Bush-advocated Health Savings Accounts. But it aims to reward those insurers that provide the most efficient blend of reasonable cost and high quality. It would offer basic preventive care at no out-of-pocket cost.

The Wisconsin Health Security Act: Sponsored as Senate Bill 51 by Sen. Mark Miller (D-Monona) and Rep. Chuck Benedict (D-Beloit), this would apply much of Canada's "single payer" model to our state. By eliminating multiple private insurers and having payroll taxes collected into a single fund administered by a publicly supervised authority, the plan would seek to reduce the enormous bureaucratic and profit-driven costs of the private insurance industry.

The Wisconsin Health Partnership Plan: This proposal, backed by the AFL-CIO, has won the support of the Wisconsin Alliance of Cities, League of Wisconsin Municipalities, and others. It would provide all Wisconsin workers and their dependents with a comprehensive set of benefits, with affordable co-pays and deductibles; employers would pay a flat monthly fee per worker. Those not covered by employment could buy into the plan at cost, with a publicly accountable entity handling all funding and payouts.

Also in the mix is legislation proposed by state Sens. Carol Roessler (R-Oshkosh) and Alberta Darling (R-River Hills) to encourage Health Savings Accounts. This is a state-level version of the approach championed by President George W. Bush. Essentially, it involves employees taking out low-cost but high-deductible insurance policies, with employers providing some payments toward routine care. The employee would be allowed to keep the unspent payments in a tax-free account.